Life After Rape: The Sexual Assault Issue No One's Talking About

The sickening truth about PTSD among survivors.

After singing at a music festival in New York City—the biggest performance of her career—29-year-old classical vocalist Lucy awoke to find that making sound, any sound, was almost impossible. "It felt like someone was strangling me from the inside," she says. An ear, nose, and throat specialist diagnosed a paralyzed vocal cord. He couldn't identify the cause of her injury, but it was permanent, he said. Irreversible.

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Devastated, Lucy spent days poring over obscure medical journals, searching for answers. That's where she stumbled across the accounts of two women who had lost their voices after being raped. Lucy began to sob. A decade earlier, she'd been sexually assaulted in a college dorm room. She had almost never spoken about it. It dawned on her that unacknowledged stress from her attack might have taken physical form. Her long-ago rape was now, quite literally, silencing her career.

As a therapist would later confirm, Lucy's seemingly random voice loss was actually a mark of post-traumatic stress disorder (PTSD). Although we tend to associate the condition with battle-scarred soldiers, studies show rape survivors have more severe PTSD, and a harder time overcoming it, than combat veterans. While between 10 to 20 percent of war vets develop the disorder, about 70 percent of sexual assault victims experience moderate to severe distress, a larger percentage than for any other violent crime.

PTSD typically takes the form of nightmares, flashbacks, and feelings of guilt and shame that can surface right away or years after a trauma. But it can also manifest in physical ways, like chronic pain, intestinal problems, muscle cramps, or, as in Lucy's case, a paralyzed vocal cord. For 94 percent of survivors, symptoms last at least two weeks; for a full half of them, they persist for years, even decades—sometimes long after the victim thinks she has laid the ghosts to rest. Consider the women, some now in their sixties, still grappling with the effects of decades-old alleged assaults by comedian Bill Cosby. German researchers found a third of women raped during World War II had PTSD symptoms nearly 70 years later.

Any trauma can lead to PTSD, but sexual assault is a particularly potent cause. Although rape is, at its core, about power, sex is analogous with pleasure and connection. Violating that intimacy can shatter a victim's trust in all relationships, fracturing the bonds with family and friends that are critical for healing. And since 75 percent of victims are attacked by someone they know, every person they meet and every situation they're in can feel dangerous, making sexual assault difficult to cope with, says Ananda Amstadter, Ph.D., an associate professor of psychiatry and psychology at Virginia Commonwealth University.

As a society, we're starting to talk more about sexual violence. Lady Gaga performed her anti-rape anthem "Til It Happens to You" at the Oscars; the assault by former Stanford swimmer Brock Turner on an unconscious woman behind a Dumpster ignited a social media firestorm—and an open letter to the victim from Vice President Joe Biden. While this dialogue is crucial to prevention, there has been a woeful silence and lack of understanding about the long-term damage and repercussions many survivors endure.

Fear and Self-Loathing

Lucy, then an 18-year-old freshman, was handed a beer as she kicked back at a party near campus. As she downed the last drops, the room started spinning. Not a big drinker, she blamed a low tolerance. When a tall athlete led her out of the party, Lucy's friend flashed a thumbs-up (she didn't intervene, thinking Lucy was just tipsy). You're hooking up with a hot athlete! Score!

He didn't take her home. Instead, he brought her to his dorm room. As Lucy faded in and out of consciousness, he took off her clothes. He rolled on a condom and used his spit as lube. Then he raped her.

Lucy woke up hours later, groggy, a scratchy blanket thrown over her half-naked body. She heard her rapist get something to eat. When one of his friends stopped by, her attacker smirkingly introduced her; it felt like he was bragging. It was all she could do not to throw up from rage and guilt. She waited for her attacker to fall asleep. Finally, at 5 a.m., Lucy snatched her clothes and walked back to her dorm. Friends brushed it off as a hookup gone wrong. "I felt like somehow I had caused it," says Lucy.

Self-recrimination is a common reaction among victims and can ultimately contribute to PTSD, says Patricia Resick, Ph.D., a psychologist at Duke University. A recent study found a full 62 percent of college rape survivors blamed themselves for the attack; 52 percent said their rapist was "not at all" at fault. Society reinforces this belief. In the aftermath of rape, we ask: "What did she expect if she was wearing a short skirt? If she was drunk?" It's a response that partly stems from our culture's near-puritanical discomfort with women's sexuality. Photos of breastfeeding women are taken off Facebook; school dress codes ban girls, but not boys, from wearing tank tops.

PTSD typically takes the form of nightmares, flashbacks, and feelings of guilt and shame that can surface right away or years after a trauma.

Victim blaming—by both men and women—is also an attempt to feel in control of our own lives. "It's easier to believe the victim did something wrong than to believe the men we know could be rapists, or that we could one day be raped ourselves," says Heidi Zinzow, Ph.D., an associate professor of psychology at Clemson University. That piling on of culpability has a devastating consequence: It becomes a secondary victimization that prevents survivors from seeking help, leaving the door wide open for distress to morph into PTSD.

And as mind-boggling as it sounds, some victims even blame themselves for that. Newspaper reporter Joanna Connors, 63, author of I Will Find You—a recent book about the aftermath of her assault—was raped at knifepoint at a university while on a work assignment more than 30 years ago. "I felt ashamed that I was 'weak.' That I didn't put myself right back together," says Joanna, whose PTSD took the form, over the decades, of panic attacks, OCD, agoraphobia, and trichotillomania (pulling out her own hair).

Downward Spiral

After the attack, nightmares regularly tore Lucy from sleep. Her grades plummeted. She found it hard to date; any hint of intimacy caused paralyzing flashbacks. She started binge-drinking several nights a week to shut out what had happened. She sought out a therapist but didn't discuss the rape; she just wanted to forget about it.

Lucy's reactions were caused by a biological maelstrom. In the days and weeks following a rape, the body is flooded with stress hormones, triggering a fight-or-flight response that can disrupt sleep and cause women to pull back from loved ones. Victims often feel on high alert, unable to relax. As long as these feelings and behaviors subside within a month, they are normal parts of the healing process, says Resick.

But often, that healing process gets stalled. Reminders of the assault—day-to-day activities like going to the gynecologist, as well as more overt events, like seeing someone who resembles the rapist—can spark negative thoughts; trying to avoid the thoughts can lead to PTSD. Dorri, now 54 and a Web designer, was gang-raped at 13. For nearly four decades, every rock song she heard (it had been playing on the radio during her assault) caused her to relive the rape. "But I didn't get help because I didn't understand what I was experiencing was PTSD," she says. For 35-year-old writer Maureen, it's been 20 years since her assault, but when she reads stories of rape in the news, "I feel like I've been punched in the stomach," she says.

That kind of chronic stress is linked to heart disease, fibromyalgia, and memory problems. About 30 percent of survivors will sink into depression or numb their pain with booze and drugs, which studies show can raise the odds of being sexually assaulted again—and another rape only solidifies their conviction that they are worthless and damaged. Others develop long-term sexual problems. Even if a woman seeks to treat the outward symptoms, the litany of health issues that stem from PTSD can worsen and amplify if the rape itself isn't addressed.

Rape Culture in Action

An important element in someone getting "stuck" in processing their trauma and descending into long-term PTSD is the lack of support from our medical and justice systems. A Michigan State University study found that, after reporting their rapes, most women felt guilty, depressed, distrustful, and "reluctant to seek further help"—all symptoms linked to PTSD. When Lucy went to the student health center to be tested for sexually transmitted infections after the rape (the results, thankfully, were negative), the physician was brusque, roughly pushing the speculum into Lucy's vagina. She seemed annoyed with yet another freshman girl seeking testing. She asked Lucy if she had been forced to have sex. Lucy said no—not an unusual response. Many survivors who seek medical attention after an assault don't disclose the rape out of embarrassment or shame, according to a study. The doctor noted in Lucy's chart that the testing was for "a sexual encounter that went further than intended" and sent her on her way. The mortifying experience made Lucy reluctant to discuss her rape again, even with family, whose support might have helped ward off her PTSD.

Women who go to law enforcement are met with an equally harrowing process. Reports show some police are dismissive of women's claims or don't attempt to gather forensic proof of the attack. When they do, it involves an invasive, hours-long exam to collect evidence for a rape kit. The victim's mouth, vagina, and anus are swabbed. Blood and urine samples are taken. Her underwear is often collected. Photos may be taken of her naked body. The most disturbing violation: The kit may never be processed.

"I didn't get help because I didn't understand what I was experiencing was PTSD."

Hundreds of thousands of untested rape kits dating back more than two decades are currently gathering dust in police stations around the country (due to a variety of factors, from lack of time and money to a detective's decision not to act). Recent efforts to clear the backlog have meant contacting survivors years after their attack, which can elicit or worsen PTSD. "Survivors expect evidence will be treated responsibly. That it's not sends a message that what happened didn't matter. They feel—rightly—that the system let them down," says Ilse Knecht, director of policy and advocacy at the Joyful Heart Foundation, a nonprofit group that's advising cities as they work through untested kits. Few police departments have the resources to handle the psychological effects of notification, or to guide survivors through the legal system.

Further damaging: Victims may not be able to do anything with the information. In most states, women are informed when a previously untested rape kit yields DNA evidence identifying their attacker—regardless of whether it's too late to press charges. (The statute of limitations varies by state: In some, it's as short as three years; in others, a rapist can be charged anytime.) Some women find that learning their rapist's identity, even if prosecuting the perpetrator isn't possible, provides validation and closure. For others, it can cause crippling powerlessness that can interfere with healing, says Knecht.

Feelings of helplessness can intensify if, at any point, a victim decides to go to trial. DNA evidence can make or break a case—but it's not a slam-dunk. Rapists often claim sex was consensual, which once again places the woman under a microscope. With or without forensic evidence, a victim must recount her assault over and over, in graphic detail. On the stand, she may be ruthlessly cross-examined by the rapist's attorney.

These reactions from doctors and the criminal justice system are another form of secondary victimization so traumatic that many survivors describe it as a "second rape," says psychologist Amy Street, Ph.D., of the U.S. Department of Veterans Affairs' National Center for PTSD. As a result, under 35 percent of all rapes are reported, and even fewer go to trial.

Even a conviction can contribute to PTSD. Reporter Joanna's rapist was sentenced to 30 years in prison. "I told myself, 'Now it's over. Move on.' " She buried her trauma for over 20 years, until her daughter started looking at colleges—the scene of Joanna's assault.

Regaining Your Voice

Although difficult, it is possible to recover from a years-or even decades-old assault. Reaching out to a professional sooner may lessen the psychological and physical toll, but "survivors should seek help whenever it feels right to them," says Cameron Clark, a clinical therapist at the Sexual Assault Center in Nashville. Just talking about it out loud can relieve some of the emotional burden. The National Sexual Assault Hotline (800-656-HOPE) is staffed around the clock; RAINN, the Rape, Abuse, and Incest National Network, has a 24/7 live chat (rainn.org) and a directory of local rape crisis centers that can help you find affordable support in your area. And they're not just for newly victimized women: While researching her book, Joanna volunteered at a local rape crisis hotline. "More of their calls came from people whose rapes happened 20 years ago than from recent victims," she says.

Hundreds of thousands of untested rape kits dating back more than two decades are currently gathering dust in police stations around the country.

Psychological therapies for rape and PTSD are effective whether you seek help right after a trauma or years down the line. To unravel the PTSD fed by Lucy's decade of silence, she had three years of Eye Movement Desensitization and Reprocessing along with somatic experiencing, a therapy that helps release physical tension in the body after a trauma. "It helped me get in touch with a subconscious layer that was always freaking out," says Lucy. Physical therapy restored her voice, proving the ENT physician wrong, to Lucy's great relief.

Even just telling a friend can be therapeutic. Research shows survivors with a strong support network are significantly less likely to develop PTSD. But pick the people you come out to carefully, says Zinzow: Studies have shown that getting an unsympathetic reaction can amplify existing PTSD. Lucy confided in her then-boyfriend (now her husband); Maureen found strength from her women's studies class in college. "I just blurted it out one day. Everyone was so kind and understanding. They just let me talk and cry," she says.

Lucy, Joanna, Dorri, Maureen, and other brave women say speaking out about rape, privately or publicly, lessens PTSD, even years later. "Trauma is like an onion—you just keep peeling it away. You're never really done with it," says Lucy. "But it doesn't have to define you."

To learn which therapies are especially effective in helping victims of sexual assault, how to help a friend who's been raped, and more, pick up the October issue of Women's Health, on newsstands now.

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